Mysterious Melasma: Misunderstood and misdiagnosed.

This brute we know as Melasma.

Melasma is a pigment disorder and can be challenging to treat. And it’s one of the most misunderstood and misdiagnosed skin conditions.

And you’ve got it!  Or, you might have it. But, you’re not sure. You’ve spoken to many skin experts, and some say it’s sun-induced hyperpigmentation, then others say, it is indeed the hormonal condition known as melasma.

So which is it?

Sometimes also called chloasma and often referred to as hyperpigmentation. Okay great, but what causes it, and how is it different from sun-induced hyperpigmentation?

That’s a good question. But before I explain, it’s worth repeating; a misdiagnosis of this skin condition is common. Which you would think, given its a skin pigment disorder wouldn’t be such a big deal. But it is. Tackled in the wrong way and the results can be disastrous!

Melasma can appear as darkened skin, but it’ll look different from blotchy pigment caused by years of sun exposure. Melasma will appear as mask-like. Usually appearing symmetrically and in particular areas of the face and body. It may appear on the upper lip, giving the appearance of a moustache or across the forehead or large patches across the cheeks a bit like a butterfly. 

The catalyst? Usually, pregnancy, hormonal birth control or hormone replacement therapy for menopause.

Melanin cells known as melanocytes are activated when the skin is exposed to UV radiation; it’s when the skin becomes tanned and thickened to protect it from future sun exposure.

Exposure to heat can trigger melasma, either directly from the sun or when the skin is becoming heated in other ways. 

Sitting in front of a fire, or leaning over a hot stove or bbq or while in an overly hot room can all trigger melasma. Even a glass of wine can send a rush of heat in the skin and the activation of melasma.

In many cases, cessation of hormonal medications or when you’re no longer pregnant will usually bring about improvement in the severity of melasma. But, not always, especially if you spend a lot of time outdoors.

Sun protection is essential in minimising melasma, however, when outside and exposed to the sun, your usual sun protection will do little to minimise melasma as sunscreens don’t protect your skin from the infrared heat of the sun.

Of course, while wearing sunscreen, you may not be getting burnt, but your skin is still getting hot, and heat is a trigger for melasma.

Why nothing’s working?

Melasma can be incredibly frustrating as if misdiagnosed and treated as sun-induced hyperpigmentation, and it can lead to a worsening condition.

Treatments such as Laser or IPL that heat the skin can be the worse thing you can do and often stimulate a further cascade of unwanted pigmentation. So, be wary if you think you have melasma and IPL or Laser have been recommended for your problem.

You may be feeling all is lost?

No, not really, there is hope. It’ll just take some time to resolve itself. Getting the correct advice is going to be crucial. Sometimes the difference between melasma and sun-induced hyper-pigmentation can be subtle.

However, if you’re able to pinpoint the arrival of your pigment with any hormonal event such as pregnancy or hormonal birth control and the pigment appears symmetrically, or in an unusual place like your upper lip, then it’s probably melasma.

But, don’t second guess, get the advice of a skincare professional.   

In the meantime, what can you do?

Whether you have melasma or sun-induced hyperpigmentation, the following will help reduce the visible symptoms of blotchy pigment.

Sun protection – Even though melasma is not directly caused by the sun, wearing a broad-spectrum sunscreen is essential. But there’s more you can do to protect your skin while it settles down.

Niacinamide – Also known as B3. It’s an excellent idea to include niacinamide in your daily protective routine. Niacinamide will protect your skin from the heat of the sun, which is one of the primary triggers of melasma.

Vitamin C – Another essential nutrient protecting your skin from the heat of the sun. Not only does topping up your skin’s supply of vitamin C protect the skin, but it will also minimise the enzyme activity that creates melanin.

Vitamin A – One of the skin’s most valuable nutrients; it’s your skin’s natural sunscreen. Unfortunately, vitamin A is destroyed with exposure to the sun, so topically applying vitamin A serum or cream every day will be essential in minimising melasma.

It’s important to note,  all three of these nutrients, vitamin’s A, C and B3 are protective and are often found to be deficient in the skin. 

Hydroquinone – A bleaching agent which is only available with a prescription from your doctor. I’m not a fan of this; however, in small controlled doses, it can help.  I recommend a thorough examination with a dermatologist if you want to try hydroquinone. 

Chemical Peels – It will largely depend on which type of peel you have. In my experience, most superficial peels, while helpful, will not eliminate melasma.

One such peel getting a lot of attention is Cosmelan and while I’ve not experienced it myself, many skin therapist that I know, highly recommend it as an option for melasma.

IPL & Laser – Not a good idea. If you have melasma, do not take this route. It will aggravate and trigger your melasma. Remember, IPL and Laser heat the skin, and any heating of the skin will make your melasma worse.